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Diabetes Care. 2015 May;38(5):767-75. doi: 10.2337/dc14-1599. Epub 2015 Feb 17.

Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes: The Diabetes and Depression (DAD) Study: A Randomized Controlled Multicenter Trial.

Author information

  • 1Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany Center for Psychotherapy Wiesbaden, Wiesbaden, Germany mail@dr-frank-petrak.de.
  • 2Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany.
  • 3Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Köln, Germany.
  • 4Diabetes Center Mergentheim, Bad Mergentheim, Germany.
  • 5Department of Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
  • 6Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany.
  • 7Interdisciplinary Centre for Clinical Trials Mainz (IZKS Mainz), University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
  • 8Clinic for Psychosomatic and Psychotherapy, University Clinic Gießen/Marburg, Philipps University Marburg, Marburg, Germany.
  • 9Department of Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany.
  • 10Vitos Clinical Centre Gießen-Marburg and Justus Liebig University Gießen, Marburg, Germany.

Abstract

OBJECTIVE:

This study compared the long-term efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) with sertraline in patients with diabetes and depression who initially responded to short-term depression treatment.

RESEARCH DESIGN AND METHODS:

A randomized controlled single-blind trial was conducted in 70 secondary care centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients with type 1 or 2 diabetes (mean HbA1c 9.3%, 78 mmol/mol) and major depression (Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders (≥50% reduction Hamilton Depression Rating Scale [HAMD-17]) were included in the 1-year study phase where CBT patients were encouraged to use bibliotherapy and sertraline patients received continuous treatment. We analyzed differences for HbA1c (primary outcome) and reduction (HAMD-17) or remission (SCID) of depression from baseline to the 1-year follow-up using ANCOVA or logistic regression analysis.

RESULTS:

After 12 weeks, 45.8% of patients responded to antidepressant treatment and were included in the 1-year study phase. Adjusted HbA1c mean score changes from baseline to the end of the long-term phase (-0.27, 95% CI -0.62 to 0.08) revealed no significant difference between interventions. Depression improved in both groups, with a significant advantage for sertraline (HAMD-17 change: -2.59, 95% CI 1.15-4.04, P < 0.05).

CONCLUSIONS:

Depression improved under CBT and sertraline in patients with diabetes and depression, with a significant advantage for sertraline, but glycemic control remained unchanged. CBT and sertraline as single treatment are insufficient to treat secondary care diabetes patients with depression and poor glycemic control.

© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

PMID:
25690005
[PubMed - indexed for MEDLINE]
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